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Home My WebLink Aboutwell info a t WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. County Name I WELL AND BORING RECORDNwaNdn /;� � Minnesota Statutes,Chapter 103.1 (' 2 6'4`1 5 Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) Date Work Completed Fl. / / GPS DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds Cable Tool ❑Driven Dug House Number,Street Name,City,and Zip Code of Well Location �or Fire Number i Auger 'Rotary Ll Jetted 10" T@Mrwk Dr- Opno DRILLING FLUID WELL HYDROFRACTURED? Yes 2rNo Show exact location of well in section grid with"X". Sketch map of wed1a tion. Nater FROM ft.TO ft. Showing operty ine N roa and but USEMonitorin Elg ❑Heating/Cooling omestic ❑Environ.Bore Hole ❑Industry/Commercial _Noncommunity PWS ❑Irrigation ❑Remedial Community PWS ❑Dewatering ❑ J CASING HOLE DIAM. w ET Drive Shoe? , Yes ❑No __;---- -____ I steel Threaded ElWelded 'h Mile [_1Plastic Elr 1 CASING DIAMETER WEIGHT 3 ___;(�in.to_ �ft. � lbs./ft. -a—in.to�_ft. 1 Mile—� in.to ft. lbs./ft. 41Lin.t237.11. PROPERTY OWNER'S NAME/COMPANY NAME in.to ft. lbs./ft. to ft. SCREEN OPEN HOLE Property owner's mailing address if different than well location address indicated above. Make FROM ft. TO5 ft4 BMW as ab m Type Diam. _ Slot/Gauze Length Set between ft.and ft. FITTINGS STATIC WATER LEVEL 1 ft. elow El above land surface Date measured 8-315 WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) .y �i� ZZS ft.after a hrs.pumping `0 —9-p.m. � r WELL HEAD COMPLETION ;p Well owner's mailing address if different than property owners address indicated above. pitless adapter manufacturer ter Model y/ ❑Casing Protection ,lel 12 in.above grade ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted X.Yes ❑No Grout material ❑Neat cemei❑Benue ❑Concrete;ligh Solids Bentonite from to ft. Ia3 — s. >9 bags fromtc ft: '""""` S. ❑bags GEOLOGICAL MATERIALSCOLOR HARDNESS OF t FROM TO from o t. ❑bags MATERIAL f ❑yds. NEAREST KNOWN SOURCE OF CONTAMINATION w. el Jim beo= Daft 0 feet direction -. type Well disinfected upon completion XYes ❑No PUMP el ay Rnft 13 ❑Not installed Date installed 9-1 —05 Manufacturer's name f% ! t 2 Model number �l HP 1.-5 volts3 Length of drop pipe 126 ft. Capacity g.p.m. Type:XSubmersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑ r,I ay bmwn tz+ ABANDONED WELLS Does property have any not in use and not sealed well(s) ❑Yes No VARIANCE h�o�c'' Was a variance granted from the MDH for this well? [:]Yes ;mMo TN# WELL CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Use a second sheet,it needed REMARKS,ELEVATION,SOURCE OF DATA,etc. Don Staiola Well Drilling Co.,, Inc. 2X72 Licensee Business Name �'�D Lic.or Reg.No. or/zed Representative S` ure /� fh,' — +' Date L+d1uck L'�re LOCAL COPY � 726435 Name of Driller HE-01205-08(Rev.5/02) IC 140-0020 w e = riv L*11 C XWat-ef- C ' 'y .P .rte 617 13th Ave So Hopkins, Minnesota 55343 (612) 935 3556 09/02/2005 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab M 522BN Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 08/31/2005 from the following location: Curt Dunnavan 1099 Tamarack Dr. Orono,Mn Well#726435 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/1 The results of these tests indicate that this well is producing water that meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. (Unless as specified by client). City Water Clinic, Inc. Bill Arsdale Lab Certification 4 027-053-119 r WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I I A O County Name WELL AND BORING SEALING RECORD Minnesota No. well No. �} henne, in Minnesota Statutes,Chapter 1031 or W-series No. L+" (Leave dank if r known) Township Name Township No. Range No. Section No. Fraction(sm i Ig) Date Sealed Date Well or Boring Constructed Orono 118 23 26 9 lun L Z Q r GPS Latitude degrees minutes seconds LOCATION: Depth Before Sealing ft. Original Depth ff. Longitude degrees minutes seconds IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location 6 Single Aquifer ❑Multiaquifer WELUBORING Measured ❑Estimated 1099 Tana Water Supply Well ❑Monit.Well t Show exact location of well or boring Sketch map of well orb ring !��/ ,,,+++...``` in section grid with"X" 55356 location,s ovyingp ❑Env.Bore Hole ❑Other ft. Ex above land surface N lines,�rgand,buildi s. CASING TYPE(S) Steel ❑Plastic ❑Tile ❑Other T— -- - - ') WELLHEAD COMPLETION W - -, ,-- -- - E �f �f Outside: E]Well House Inside: E]Basement Offset &mid p�Pitless Adapter/Unit E]Well Pit '�-- i --i'- I t' !1 1 —w� N ❑Well Pit ❑Buried S I f rr^,- F-1 Buried PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diame r Depth r Set in oversize hole? Annular space initially grouted? Property owner's mailing a if iffier c ti dress indicated above / in.from t0 I ft. ❑Yes lo E]Yes ❑No E]Unknown in.from to ft. ❑Yes ]No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE r / Well owner's mailing address if different than property owners address indicated above Screen from_ _ to_. _ft. Open Hole from W�to��ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill )KNo Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM FORMATION TO Obstructions removed? ElYes ElNo Describe If not known,indicate estimated formation log from nearby well or boring PUMP .j M Type fes-_ ❑ Removed ANot Present ❑ Other '1 3 t1 f METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: r IQ`No Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 Ibs.) Grouting Material N �T`-I.—/n.":/✓'27rom to ft. yards bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes X. How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report is true to the best of my knowledge. TION STODOLA WELL DRILLING CO. #. INC. 27172 Cont�,acto,Busine N;pe ,w License or Registration No. 240806 y Aut ze epresentative Signature- Date LOCAL COPY — Name of Person Sealing Well or Boring